This week I have a chance to do a lecture about EMR to a bunch of med students at a local medical school. There are so many facets to EMR, that I’m really trying to figure out which EMR concepts would be most valuable to a med student. I’d love to get some feedback from my readers on what they think would be most valuable. I’d especially like to hear from any doctors about what they wish they’d known about EMR when they were in medical school.

If you have ideas and suggestions, please leave them in the comments or if you prefer to keep your comments private, you can fill out my contact form. I’d really like to provide these students the most valuable information possible so your feedback is really appreciated.

Many people know that I’m quite fascinated by Twitter. I love it and I love connecting with people on Twitter. However, today I came across a clearly fake twitter account. At least to me it was easy to see it was fake. It was a twitter account supposedly for Dr. David Blumenthal. Yes, the name might be familiar to many people here. How did I know it was fake? It linked to some awful news site. Plus, the tweets were just odd and so you could tell it wasn’t really Blumenthal at all.

What scares me is that many people in IT and healthcare won’t know that it’s not him. In fact, that’s why I’m not going to add a link to the fake account. I guess there’s no harm in someone following a fake account. Some of the fake accounts on twitter are really funny. In this case it was someone just promoting their waste of a website. That’s not something I like.

I’ve posted my personal twitter account on here before, but I recently just started a general EMR, EHR and HIT twitter account. It’s currently aggregating some of my favorite HIT and EMR bloggers. We’ll see how it evolves over time. I know I’ve used it to keep track of a bunch of great content that’s being created.

Also, thanks for those who have signed up for the EMR and HIPAA email subscription. It’s been growing like crazy. Nice to think that people enjoy the content I’ve created.

I recently became aware of a new open source tablet EMR that was going to be offered by Medscribbler. Everyone that reads this blog should know that I’m a huge fan of open source (see my previous posts about open source EMR). It’s about time that a really strong tablet based EMR software was available as open source software.

Open source EMR purists will probably be a little disgruntled that Medscribbler is built on top of other technologies which are not completely open source. However, I give them a pass for now since the open source community has so far failed to deliver very good tablet based software.

You can find more information about the free Medscribbler EMR software here or at their sourceforge page. The following is the official press release announcement:

Medscribbler is released as an Open Source electronic medical record

Scriptnetics, the leader in Tablet PC mobile healthcare applications, will announce Monday its release of the proprietary source code for Medscribbler electronic medical record, EMR, to the open source community. Installable components and the code for programmers are available at the globally recognized open source portal, Sourceforge.net.

“Releasing a Medscribbler Open Source EMR is the next logical step to drive the innovation that is needed to get to a point where the majority of physicians and other health care providers take up electronic medical records,” said Michael Milne, Chief Executive Officer of Scriptnetics. “We hope to encourage a stable, widely available and affordable entry level EMR that uses cutting edge technology with the mobility of the Tablet PC,” he continued.

To provide focus and stability to move the project forward Scriptnetics has assigned programmers to manage and contribute new programming code on a regular basis. Other programmers wanting to contribute but needing help in understanding the considerable amount of code that already exists can access live help and support. For programmers looking to maximize their skills, project suggestions are posted in a forum.

The new Open Source EMR is called Medscribbler Community and is the first vertical, enterprise level open source project to be designed specifically for handwriting recognition on the Tablet PC. Medscribbler Community is already being used by many healthcare providers both in stand alone computer situations and client server multi computer offices. This cutting edge EMR is also being used in Internet WAN mobile remote access situations.

Scriptnetics is the largest vendor of penable Tablet PC designed medical software in the world. The company’s flagship product, Medscribbler, has been distributed since 2003 and is being used by healthcare providers in the United States and Canada. Its offices are located in Wilmington, Delaware and Moncton, New Brunswick. www.scriptnetics.com and www.medscribbler.com

SourceForge’s web sites connect millions of technology professionals and enthusiasts each day. Combining user-developed content, online marketplaces and e-commerce, SourceForge is the global technology community’s information exchange network and the world’s largest open source software development and distribution environment. Its offices are located in Mountainview, California.

For more information on Medscribbler Community see: www.emrfreesoftware.com and sourceforge.net/projects/medscribbler/

Press Contacts:
Michael Ferguson
Scriptnetics
(506) 859-9271
prnews@scriptnetics.com

Full Disclosure: Medscribbler is a an advertiser on EMR and HIPAA.

If you’ve been reading this blog for a little while, you might have noticed that I’m really struggling with whether I should use the term EMR or EHR. You can read about the difference between EMR and EHR on the wiki.

The problem I have is that for all practical purposes, EMR and EHR are being used synonymously. Yes, if we get to the nitty gritty there is a difference. However, if a doctor says they use an EMR or EHR in their office they’d mean the exact same thing. If I say I’m helping someone select an EMR or EHR in their office it would mean the same thing.

Basically, every EMR software could be called an EHR software. It’s really just branding. My problem is that I prefer the term EMR. It’s what I first used (thus the name of the website) and it’s what I used exclusively on this website for a couple years.

Now it’s en vogue to use the term EHR. I’m not very fond of the term EHR, but I almost feel like I have to use it since it’s the term people are starting to use more and more.

What kills me even more is that I want to be at the top of Google for EHR and EMR. However, Google doesn’t have common sense to realize that they’re essentially the same thing and should be ranked in similar ways. So, I walk this balance of using both terms and mastering neither of them on Google.

Since I’m on Google, I also want to openly tell Google to stop messing around with my Google Rank for the term EMR. Google keeps bouncing this website from the first page to the second page. Obviously the first page sends a lot more traffic this way and so you can imagine which I prefer. More importantly, Google should realize that this website is easily in the top 10 websites talking about EMR. If someone can show me 10 websites about EMR that are better than mine, then I’ll take it back. Until then, Google please place EMR and HIPAA permanently on the first page of results for the term EMR. Thanks!

I recently posted about CCHIT joining Twitter. Seems like a decent number of EMR and HIPAA readers are also on Twitter, because I’ve been getting a pretty good number of new followers in the HIT and EMR field.

As my 1423 followers and 2302 updates prove, I like Twitter a lot and really enjoy the way it can help people to connect (I’m techguy if you want to follow me). It’s really quite amazing how 140 characters could turn out to be so valuable and to a wide variety of markets too.

What was really interesting is I recently saw 2 EMR companies join the Twitter revolution: eMDs and NextGen. I think that it’s really smart for an EMR company to join the conversation. At least if it’s done right. So far they only have 8 tweets and 41 tweets respectively. It will be interesting to see how these 2 EMR vendors use twitter over time.

I tweeted one of these companies the following tweet, “How do you plan on using Twitter? Do you have a plan or are you just testing the waters?”

Their response was, “We’re just getting started, but hope to expand communication w/ customers & others in the industry & connect w/ the EHR community”

One thing is certain, we’re just seeing the beginning of what’s possible with Twitter. It’s going to be really fun to see what creative people are able to do with twitter and healthcare.

If you know of other EHR vendors or other important HIT people on twitter, please let me know in the comments.

I was recently reading a post on EMRUpdate (great EMR Forum) by a man I highly respect who goes by CEOMike. In his long post, he made the following short analysis that I thought was really interesting:

I thought by now you would have figured out EMR vendors are LIARS, making some of the bankers look like choir boys. I have done other posts on the install base claims of vendors. Figure it out 4% (studies show) of approx 400,000 primary care docs is only about 16,000 EMRs in use. Divide that by the approximately 400 EMRs [see my list of over 400 EMR companies] that have been listed in the last three years = 40 users per EMR Or go at the other way – take all claims by EMR vendors and add them up (I did this exercise a few years back) and you get something like over a million doctors using EMRs???

The million EMR installs seems a little high, but the point is well made. How do we really get accurate data about install base? The answer is that you really can’t from most vendors.

When we first implemented our EMR, we were told that they had close to 100 college health centers. Little did they ask (I wasn’t there when they selected this particular EMR) how many of the 100 health centers actually used EMR versus just their practice management system. Let’s just say I was quite surprised by the reality.

That didn’t deter me. In fact, if anything it motivated me to make it happen. Still today I think our clinic is the most cutting edge in our category for use of EMR. I enjoy that feeling and I enjoy when other clinics want to come and take a look at what we’re doing. Yes, I am sure they want to see our EMR and not just have a trip to Las Vegas.

I recently got an email notifying me that there a CCHIT twitter account added me. Is CCHIT on twitter? So far they have an account created and are following 68 people and 64 people are following them. The odd thing is that the CCHIT twitter account hasn’t posted a single tweet. There is a link on the CCHIT twitter profile to the CCHIT website. At first I thought this might be a fake CCHIT twitter account (could be kind of fun), but I really think it’s the official CCHIT that created it. Too bad they don’t understand how to use Twitter, or maybe that’s a good thing. I’ll leave that open for interpretation.

I’m on Twitter as well using the name Techguy and have a ton of HIT and EMR people following me. I often break into EMR and HIT discussions, but I also use that Twitter account for local things, technology in general, and anything I feel like posting. So, if you’re expecting to just read about EMR and HIPAA, then don’t follow my Twitter acount. However, if you don’t mind a little bit of everything, I’d love to have more people in the EMR and HIT industry following me. I’ll follow you back.

For those of you who aren’t on Twitter or have never heard of Twitter, I’ll just say “Try it, you’ll like it.” I’ve found you either get Twitter or you don’t. Someone can’t really explain Twitter to you.

In a recent thread over at EMRUpdate (best EMR forum out there) someone made the assertion that the reason that so many doctors hate EMR is because far too many vendors are focused on making the quick buck rather than providing EMR purchasers TLC (Tender Loving Care). The poster then espoused one EMR vendor has having TLC for purchasers of their EMR.

After espousing other EMR vendors who love their customers, that EMR vendor then posted the following comment about his EMR, loving customers and the EMR industry:

This business is tough and tough for many reasons. Now that the smell of money is permeating the air with Obama’s HIT initiative, it will be like sharks in a feeding frenzy. Anybody and everybody will try to enter the market and makes lots of marketing noise with new venture capital money (if there is any left out there!).

There is no clear cut “best EMR”. We cater more to physicians who expect that there will be work and some level of frustration in going to a paperless record. We attract physicians who are willing to (and frankly want) to put in the infrastructure to have control over their EMR (read: buy a server, put in a network). Our users are those who intuitively understand that there is no software in the world which will replace their paper-filled processes with nary a hint of change. Their intuition also tells them that there is no EMR that can duplicate their level of skill……there will have to be some tweaking of templates and clinical content.

So I love our customers. That is no secret, but I love them because we can work together to build a better solution. They provide lots of feedback, are patient (most of the time), are thoughtful, are goal oriented, are smart, are owners (and managers) of their practice. Their decisions stand (ie, get outta Dodge if you aren’t on-board with an EMR I can hear them saying to a foot-dragging staff member). Others need not apply.

In short, Medtuity is not for the masses of physicians. Our phone rings pretty much non-stop…..and that is also why Obama’s HIT plan will fail. It takes too much caring.

Kind of rare to find such stark honesty in the EMR industry. An EMR vendor who actually tells doctors that there’s going to be “work and some level of frustration in going to a paperless record.” Reminds me of a loving father trying to prepare a child for the future heartache they are sure to experience. Sounds like an EMR vendor love to me.

Does your EMR vendor love you?

I’m guessing that many of my readers may be surprised that I work with a CCHIT certified EMR every day.  It’s true.  I got hired to implement an EMR at least a year or two before CCHIT even existed.  In fact, I wasn’t even part of the selection process.  I just did everything I could to make it a successful implementation.  By almost all measures, the users of this EMR are happy we implemented this EMR.

Does it matter that this EMR is CCHIT certified?  Not really.  We implemented it well before it met all the laundry list of CCHIT certification criteria.  Have we made a CCHIT certification be very beneficial for our clinic?  Certainly.

Unfortunately, it kind of masks my biggest problem with my EMR software company putting such a strong emphasis on CCHIT certification.  My problem is that for at least one major software version life cycle, my EMR was focused on CCHIT certification as opposed to the forward thinking improvements that could have been implemented.

As if one software lifecycle wasn’t enough, I just heard that they’re going to be spending another version on this year’s CCHIT certification.  Basically, almost all innovation on the product that could have been used to satisfy the customers has been put on hold to appease a certification requirement.

I’m not saying that CCHIT certification is all bad.  For example, I’m told the latest CCHIT certification includes a requirement for a button which can print the entire medical record with one click.  Our HIM staff will love this feature and I’ve been told CCHIT certification was the driver behind this feature.

Who’s to say that this feature wouldn’t have been pushed to the top of the priority list even without CCHIT certification?  However, I can’t help but wonder what other more innovative feature we could have had in its place.

We now interrupt all this HITECH act EHR stimulus money talk for our regularly scheduled program.

If you are looking at implementing EHR, then you better become familiar with a nice high quality scanner. Don’t believe anyone who tells you that they are paperless. Sure, many don’t store paper, but even the very best EMR or EHR implementation has loads of paper that needs to be scanned.

Still don’t believe me, then how do you plan on handling a new patient who brings in a stack of paper records from their old doctor. I’ll leave the rest of the list of possible paper for another day. Suffice it to say that you’ll NEED a high quality scanner that can handle high volume.

When we first implemented we used a nice little all in one scanner. Worked well, except we literally burnt it out after less than a month of scanning.

After that we finally ponied up the money and bought some high quality, high volume fujitsu scanners. 4 years later we’re still scanning with no end in sight. We do have to do regular cleaning (about 5 minutes max) to clean off all the ink that gets on the feeder. Otherwise, these babies are the best I’ve seen. Here’s links to the 2 models fujitsu currently offers.

Fujitsu fi-6130 Duplex Scanner

Fujitsu FI-6230 Clr Duplex 40PPM/30PPM USB
Flat bed and ADF feeder:

One has a flat bed for those hard to feed scan items (ie. prescriptions) and the other is just the feeder for the high volume scanning.  Some may think it’s a little expensive for a scanner, but it’s worth it.

I’ll be updating my list of EMR and EHR technology with items like the scanners above. Many people have asked me which scanners are best, which computers are best, what about tablets, fax servers, etc, etc. Now you can just check out my list of software, tablets, computers, fax servers, scanners, printers, etc and see some recommended items to help your office.